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Sternal resection for Osteophyte ??

  1. #1
    Default Sternal resection for Osteophyte ??
    Medical Coding Books
    I've recently took on a new specialty for me and i'm just really nervous about missing something.... so i wanted someone to double check this one for me....


    POSTOPERATIVE DIAGNOSIS:
    Sternal manubrial osteophyte.

    OPERATIVE PROCEDURE:
    Resection of sternal osteophyte
    .

    ANESTHESIA: General.

    HISTORY: The patient is a 53-year-old gentleman with a
    pronounced sternal manubrial osteophyte, which has been hampering
    his ability to perform his job. He is brought to the OR at this
    point in time for resection and remodeling of this sternal
    osteophyte area.

    PROCEDURE: The patient was brought in the operating room and
    placed in the supine position and underwent induction of general
    anesthesia. The chest was then prepped and draped in the routine
    sterile fashion.

    A vertical incision was made to the right side of the osteophyte.
    Using retraction we were able to dissect up under the skin and
    incise the muscle and soft tissues down the osteophyte itself.
    The osteophyte limits were then defined. Using a chisel the
    majority of this osteophyte was removed using chisel and mallet.
    Once we had resected most of it we used a rongeur to carefully
    remodel this area. Bone rasp was then brought up in the area and
    this was smoothed off. After working on this a bit to get the
    contours right the area was irrigated. Soft tissue was pulled
    over the bony area using running 3-0 Vicryl. The skin was
    reapproximated using running subcuticular 4-0 Vicryl. The wounds
    were cleaned and dressing applied.

    so i'm thinking:

    21627 but would i use the the closure, 21750 too?
    Dx- 726.91

  2. #2
    Location
    Richardson, TX
    Posts
    823
    Default
    Quote Originally Posted by sslater View Post
    I've recently took on a new specialty for me and i'm just really nervous about missing something.... so i wanted someone to double check this one for me....


    POSTOPERATIVE DIAGNOSIS:
    Sternal manubrial osteophyte.

    OPERATIVE PROCEDURE:
    Resection of sternal osteophyte
    .

    ANESTHESIA: General.

    HISTORY: The patient is a 53-year-old gentleman with a
    pronounced sternal manubrial osteophyte, which has been hampering
    his ability to perform his job. He is brought to the OR at this
    point in time for resection and remodeling of this sternal
    osteophyte area.

    PROCEDURE: The patient was brought in the operating room and
    placed in the supine position and underwent induction of general
    anesthesia. The chest was then prepped and draped in the routine
    sterile fashion.

    A vertical incision was made to the right side of the osteophyte.
    Using retraction we were able to dissect up under the skin and
    incise the muscle and soft tissues down the osteophyte itself.
    The osteophyte limits were then defined. Using a chisel the
    majority of this osteophyte was removed using chisel and mallet.
    Once we had resected most of it we used a rongeur to carefully
    remodel this area. Bone rasp was then brought up in the area and
    this was smoothed off. After working on this a bit to get the
    contours right the area was irrigated. Soft tissue was pulled
    over the bony area using running 3-0 Vicryl. The skin was
    reapproximated using running subcuticular 4-0 Vicryl. The wounds
    were cleaned and dressing applied.

    so i'm thinking:

    21627 but would i use the the closure, 21750 too?
    Dx- 726.91
    No, because per CCI these codes are bundled and no modifer is allowed. And what your physician is doing does not seem to meet CPT 21750;

    "The physician performs sugery on the sternum bone to put the bone back together following previous surgical separation. Under andesthesia, an incision overlying the sternum is made and carried deep to the bone and separated pieces are identified. Physician may debride soft tissue or bone. The bony fragments are manipulated back together and held in place. Wires or other internal fixation devices to maintain the bone in appropriate position"

    21627 is probably your better option.
    Julie Graham, BA, CPC, CCC

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